Quantitative multiparametric MRI as a non-invasive stratification tool in children and adolescents with autoimmune liver disease

AbstractAutoimmune hepatitis (AIH) and autoimmune sclerosing cholangitis (ASC) are two very closely related autoimmune liver diseases with overlapping clinical features and similar management strategies. The purpose of this study was to assess the utility of quantitative imaging markers to distinguish ASC from AIH in paediatrics. 66 participants (N = 52 AIH, N = 14 ASC) aged 14.4 ± 3.3 years scheduled to undergo routine biopsy and baseline serum liver biochemistry testing were invited to undergo MRI (non-contrast abdominal MRI and 3D fast spin-echo MRCP). Multiparametric MRI was used to measure fibro-inflammation with corrected T1 (cT1), while the biliary tree was modelled using quantitative MRCP (MRCP +). Mann–Whitney U tests were performed to compare liver function tests with imaging markers between patient groups (ASC vs AIH). Receiver operating characteristic curves and stepwise logistic regressions were used to identify the best combination of markers to discriminate between ASC and AIH. Correlations between liver function tests and imaging markers were performed using Spearman’s rank correlation. cT1 was significantly correlated with liver function tests (range 0.33 ≤ R ≤ 56, p < 0.05), as well as with fibrosis, lobular and portal inflammation (range 0.31 ≤ R ≤ 42, p < 0.05). 19 MRCP + metrics correlated significantly with liver function tests (range 0.29 ≤ R ≤ 0.43, p < 0.05). GGT and MRCP + metrics were significantly higher in ASC compared to those with AIH. The best multivariable model for distinguishing ASC from AIH included total number of ducts and the sum of relative severity of both strictures and dilatations AUC: 0.91 (95% CI 0.78–1). Quantitative MRCP metrics are a good discriminator of ASC from AIH.

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Sclerosing cholangitis in a patient treated with nivolumab

BMJ Case Reports ◽

10.1136/bcr-2021-241700 ◽

2021 ◽

Vol 14 (5) ◽

pp. e241700

Author(s):

Sam Talbot ◽

Vivienne MacLaren ◽

Heather Lafferty

Keyword(s):

Liver Function ◽

Sclerosing Cholangitis ◽

Biliary Tree ◽

Liver Function Tests ◽

High Dose ◽

Mr Cholangiopancreatography ◽

Small Cell Lung ◽

Function Tests ◽

Stage 4 ◽

History Of

A 69-year-old retired miner with stage 4 non-small-cell lung cancer presented with a 2-month history of obstructive liver function tests following nivolumab immunotherapy. His case had not responded to high dose prednisolone or mycophenolate and he was admitted for investigation. MR cholangiopancreatography demonstrated areas of intrahepatic biliary tree beading and stricturing, in keeping with sclerosing cholangitis. Prednisolone and mycophenolate were stopped and ursodeoxycholic acid commenced with subsequent partial improvement of the patient’s liver function tests.

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Cholangiolytic Changes in Statin-Induced Liver Injury

Case Reports in Pathology ◽

10.1155/2020/9650619 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Preethi Dileep Menon ◽

Tamneet Singh ◽

Hopethe Hubbard ◽

Sarah Hackman ◽

Francis E. Sharkey

Keyword(s):

Liver Injury ◽

Liver Function ◽

Biliary Tree ◽

Liver Function Tests ◽

Ampulla Of Vater ◽

Drug Induced ◽

Drug Induced Liver Injury ◽

Function Tests ◽

Atorvastatin Therapy ◽

Mixed Pattern

Atorvastatin is a commonly used oral cholesterol-lowering agent. Side effects associated with statin therapy include arthralgia, myalgia, dyspepsia, weakness, and headache. Prospective and retrospective studies of drug-induced liver injury have identified statin-induced hepatotoxicity, with atorvastatin being the most commonly cited. Associated liver function test elevations have varied from hepatocellular to cholestatic/mixed pattern. We report a case of a 58-year-old woman that illustrates unusual histologic findings associated with a mixed pattern of statin-induced liver injury. While being treated with atorvastatin, the patient exhibited repeated bouts of abdominal pain over a year associated with biliary tree dilation, variably attributed to postcholecystectomy dilation and stenosis of the ampulla of Vater. Following sphincterotomy, the patient’s bilirubin normalized but the other liver function tests remained elevated. Liver biopsy revealed portal and lobular inflammation with cholangiolysis. The patient’s liver function tests normalized following cessation of atorvastatin therapy.

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The Effect of Saffron Consumption on Liver Function: A Systematic Review and Meta-Analysis of Randomized Controlled Clinical Trials

Complementary Medicine Research ◽

10.1159/000515003 ◽

2021 ◽

pp. 1-10

Author(s):

Elham Karimi ◽

Amirhosein Farrokhzad ◽

Mina Darand ◽

Arman Arab

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Liver Function ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Adult Population ◽

Rank Correlation ◽

Liver Function Tests ◽

Randomized Controlled ◽

Function Tests

Background and Aims: The present systematic review and meta-analysis of randomized controlled trials aimed to determine the effects of saffron supplementation on liver function tests among adults. Methods: Electronic databases including PubMed, ISI Web of Science, and Scopus were searched up to January 2021. The risk of bias in individual studies was assessed using the Cochrane Collaboration tool. The overall estimates and their 95% CIs were calculated using random-effects models. Egger’s test and Begg’s rank-correlation were run to assess the presence of publication bias. p < 0.05 was considered statistically significant. Results: A total of 12 trials involving 608 participants were included in this systematic review and meta-analysis. Saffron supplementation had no significant effect on liver function tests including aspartate transaminase (AST) (weighted mean difference [WMD] = 0.23 U/L; 95% CI –2.22 to 2.69; p = 0.851; I2 = 74.0%), alanine aminotransferase (ALT) (WMD = –1.49 U/L; 95% CI –3.84 to 0.86; p = 0.213; I2 = 60.2%), and alkaline phosphatase (ALP) (WMD = –0.70 U/L; 95% CI –11.35 to 9.95; p = 0.898; I2 = 40.8%) compared to placebo. Conclusion: Based on what was discussed, it seems that saffron supplementation could not improve liver function tests including AST, ALT, and ALP among the adult population. Further clinical trials with larger sample size, longer duration, and higher doses of saffron should be conducted exclusively among patients with liver dysfunction to elucidate the beneficial role of saffron consumption on liver function.

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